HomeMy WebLinkAboutCF Overhead Sprinkler Hydro Test 2018 (2)25-104 INSPECTION, l ESTING, AND MAINTENANCE OF WA 1 hR-BASED FIRE PROTECTION SYS 1 EMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR, Title 19
Name: Ca 1 1----;,.-._ 1-7 _ Occupancy/Use:
Address: q > 92 Construction Type:
i %4OF CALIO tr
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City: Co //a V;i-4'f No. Stories:
r
0,. eri i, 10
0 ?,—' D
ZIP Year Constructed:
rrti
9 �i / Pi
Contact:
% P'
hE MM
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Telephone: r /
1'=r ;t,:.r.,
`�` G'' -a - Copy sent to:
Name: �a t
t�' L`k.. caner Date: � ...4. —/ cr
Address: / � ;T �� t'Gt !Y
City )+-4 /G'ti' ) lore AHJ Date: fr j - / cr
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State: C _ (. Contractor Date: 6 .-6,,,- C b-,
(4-
Telephone: 6-'36') l.j I''�/U3
NOTES:
1) For specific inspection, testing, and maintenance
//
CA License#: -11/6 9 7,
requirements and information, see NFPA 25, 2011
edition as amended by Califomia Code of Regulations,
Job #:
Title 19, §901 to §906.
)
Performed by:
2) Inspection items may be performed by the owner in
accordance with California Code of Regulations, Title 19,
§904.1(a)
,.;1;-, ,
Forms Included with this Report
VW
74 Automatic Sprinkler System
+. - r _
NFPA 25
Chapter
5
;moi r �. ."y_
Number of Forms
0
,�
N/A
1
Fait'
Pass
.A.
• Standpipe and Hose System
6
0
1
■ Private Water Supply System
7
0
f
❑
• Fire Pump
8
0
1/
■ Water Storage Tank
9
0
/
U
• Water Spray System
10
0
1/
—
E
• Foam Water Sprinkler System
11
0
f
C
■ Water Mist System
12
0
1
■ Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas)
■ Yes
■ No
AES 1
NOTE: — Strikeout items are not applicable in California
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September 3, 2013
ANNEX B
25-105
Wet Pipe Califomia Code of Regulations - Title 19 Quarterly and
Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report
1 of 3
Property Information
Building Name C C h f' (; "ICA
Address 5L [,7(7�� 1 jt j
City r, f71A`z X1.7
Contact Person
License # 1162971
SFM
Contractor or Licensed Owner Information
Name
Addressj7
%) 7
,+1
City ot.'2 St. zip9‘-&,)/
Phone c3I,1 t7 ,Z11/ 2. 6,9
Job #
CSLB
Misc.
Riser information
Main Drain Test (Annual)
This building has more than 5 risers. See additional AES 2.9 form attached.
NM'
Number of AES 2.9 forms attached
Form AES 2.1
NOTE: — Strikeout items are not applicable in California
0:0145,,
Wafti
Sept. 3, 2013
=
P 1 . spec Ion
Inspection T = Test M = Maintenance_
P -Pass F = Fail NIA = Not Applicable
1.1
I
Control Valves - Identification Sign
11SEAS
13.3.1
2'
1.2
1
Control Valves - Inspection
13.3.2
1.3
I
Waterflow Alarm Devices
5.2.5
1.4
1
Supervisory Devices
5.2.5
1.5
I
Gauges (Wet Pipe Systems)
5.2.4.1
1.6
I
Enter Water Supply Pressure Below Riser Check
5.2.4.1
psi
psi
psi
psi
1.7
I
Enter Water Supply Pressure Above Riser Check
5.2.4.1
psi
psi
psi
psi
1.8
I
Pressure Readings Acceptable
5.2.4.1
1.9
I
Hydraulic Design Information Sign
(For Hydraulically Designed Systems)
5.2.6
1.10
I
General Information Sign
(Not Required for System prior to 2007 Edition of NFPA 13)
5.2.8
1.11
I
Heat Tape
5.2.7
1.12
I
Spare Sprinklers
5.2.1.4
1.13
1
Fire Department Connections
13.7
1.14
I
Alarm Valves - Exterior Inspection
13.4.1
1.15
1
Pressure Reducing Valves
13.5.1.1
1.16
I
Backflow Preventers
13.6.1
1.175.1.6,
Hose Connections - Hose Valve*
5.1.6, 13.5.2
13.5.5.1
1.18
I
PRV - Fire Sprinkler Systems
13.5.1.1
* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include
standpipe systems.
Class I
II, or III
Form AES 2.1
NOTE: — Strikeout items are not applicable in California
0:0145,,
Wafti
Sept. 3, 2013
25-106 INSPECTION, TESTING. AND MAINTENANCE OF WATER-BASED FIRE PROTECTION SYSTEMS
Wet Pipe
Fire Sprinkler System
California Code of Regulations - Title 19
Quarterly and
Inspection, Testing, and Maintenance Annual Report
2 of 3
Property Information
Building Name (.....„41G �" P 'l , } 7 Z
Address 53-6? / ,�`fc`�
City
Contractor or Licensed Owner Information
Name 1Z' t y—it
Job # -
ANNUAL INSPECTION, TESTING, AND MAINTENANCE
Include ALL Quarterly inspections
= inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Ayliceble
1.19
I
Sprinklers
5.2.1
,
L
1.20
I
Buildings (Freeze Protection)
4.1.1.1
Owner's Responsibility
,�,Q
1.21
1
Pipe and Fittings
5.2.2
gj1�
1.22
I
Hangers
5.2.3
1.23
I
Seismic Braces
5.2.3
7/7
2.1
T
Field Service Test Required
(Send Report to Fire Code Official)
5.3.1
If REQUIRED, Enter 'F' until
results are returned from Lab
r!
j' �l,;
/ '1r
2.2
T
Recalled Sprinklers
If not present = Pass; If present = Fail
Title 19
904.1(c)
2.3
T
Water Flow Alarm Devices
90 sec, maximum - (Enter Time)
5.3.3
13.2.6
seC._
._
2.4
T
Main Drain Test
(Enter Data on Page 1 of this Form)
13.2.5
13.3.3.4
2.5
T
Control Valve - Position
13.3.3.2
2.6
T
Control Valve – Operation
13.3.3.1
r)
2.7
T
Supervisory Devices
13.3.3.5
2.8
T
Backflow Preventer Assemblies
13.6.2
A/4
2.9
T
Small Hose Connections'
w/PRV Hose Valves – Partial Flow Test
13.5.2.3
13.5.3.3
/(.f
2.10
T
PRV – Fire Sprinkler Systems
13.5.1.3
4/4
3.1
M
Control Valves
13.3.4
1)
4
3.2
M
Small Hose Connections*
13.5.6.3
A1/4
3.3
M
Obstruction Investigation required
(If "Yes'. see Deficiencies and Comments Section
for Results.)
14.3
Yes
Yes
o
��
3.4
M
System Returned to Seryice
4.5.3
Noes
• Small hose connections are hose valves and optional hose supp ied by the fire sprinkler system. They do not include Class I, II, or III
standpipe systems.
D = Deficient C = Comment
Item Date Riser
Indicate
D
e
Deficiencies and Comments
Inddcate a;; equ;pment, devices and parts that ware repaired or replaced
•
Form AES 2.1
NOTE: — Strikeout items are not applicable in Californiawaivaliewi
Sept. 3, 2013
ANNEX B
25-107
Wet Pipe
Fire Sprinkler System
Califomia Code of Regulations - Title 19 Quarterly and
Inspection, Testing, and Maintenance Annual Report
3 of 3
Property Information
Building Name u G (—,"moi j /I 2 -7 --
Address '`� Cern He< f -1-
City ( [' f tied °«
/kof CAL,,,
y ` ��l a o9Z%
Contractor or Licensed Owner Information
Name
Job # t/
D = Deficienc C = Comment Indicate
item Date Riser D C
Deficiencies and Comments (cont)
Indfca'e all equipment, devices and parts that were repaired orreplaced
1 T L i 1=-;(. i /V , l ✓�+ 4
LJCheck here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
See Correction Form AES 10 for corrected deficiencies. Number attached:
I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by
the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable
except as noted in the "Deficiencies and Comments" section of this form.
Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter
Dale
Print Name —i
Signature
Form AES 2.1
NOTE — Strikeout items are not applicable in California
Shaded � t £tdn s r l forni iii 't
Sept 3, 2013